| 陈新馨,林彩娜,冯敏.6 min 步行试验联合血清细胞因子对慢性心力衰竭患者预后的评估价值[J].中华老年多器官疾病杂志,2023,22(4):262~267 |
| 6 min 步行试验联合血清细胞因子对慢性心力衰竭患者预后的评估价值 |
| Evaluation value of 6-minute walk test combined with serum cytokines for prognosis of chronic heart failure |
| 投稿时间：2022-10-25 |
| DOI：10.11915/j.issn.1671-5403.2023.04.054 |
| 中文关键词: 慢性心力衰竭 6min步行试验 白细胞介素-22 肿瘤坏死因子-α 核因子-κB 预后 |
| 英文关键词:chronic heart failure 6-minute walk test interleukin-22 tumor necrosis factor-α nuclear factor-κB prognosis This work was supported by the Medical Project of 2020 Qionghai Science and Technology Plan |
| 基金项目:2020年琼海市科技计划项目医疗类(2020-03) |
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| 中文摘要: |
| 目的 探讨6min步行试验(6MWT)联合血清细胞因子对慢性心力衰竭患者(CHF)预后的评估价值。方法 选取2020年1月至2021年1月琼海市人民医院收治的82例CHF患者为研究对象。收集患者临床资料及左心室射血分数(LVEF)、纽约心脏病协会(NYHA)心功能分级及血清氨基末端脑钠肽前体(NT-proBNP)水平等心功能指标。患者入院后行6MWT试验,检测白细胞介素-22(IL-22)、肿瘤坏死因子-α(TNF-α)及核因子-κB(NF-κB)等血清细胞因子水平。采用SPSS 19.0统计软件进行数据处理。采用Pearson或Spearman相关法分析6MWT及血清细胞因子水平与心功能指标之间的相关性。采用受试者工作特征(ROC)曲线评估各指标对CHF患者预后的预测价值。采用Cox风险比例回归模型分析影响CHF患者预后的独立危险因素。结果 随访1年,失访患者2例,根据不良终点事件发生情况分为事件组(n=36)与非事件组(n=44)。事件组6MWT显著低于非事件组[(301.25±36.78)和(413.51±42.36)m],血清IL-22[(643.51±53.69)和(511.07±60.11)pg/ml]、TNF-α[(412.15±56.69)和(284.55±35.79)ng/L]及NF-κB[(96.67±13.69)和(70.05±12.57)pg/ml]水平均显著高于非事件组,差异均有统计学意义(均P＜0.05)。NYHAⅡ级患者6MWT显著高于NYHAⅢ级患者[(390.52±45.87)m和(346.47±43.15)m],血清IL-22[(540.09±60.33)和(589.01±58.77)pg/ml]、TNF-α[(325.21±53.69)和(352.02±54.77)ng/L]及NF-κB[(78.07±10.85)和(84.04±11.33)pg/ml]水平均显著低于NYHA Ⅲ级,差异均有统计学意义(均P<0.05)。相关性分析提示,CHF患者6MWT与LVEF呈正相关(r=0.511,P<0.001),与NYHA心功能分级(r=-0.405,P=0.012)及血清NT-proBNP水平均呈负相关(r=-0.456,P<0.001)；血清IL-22水平与LVEF呈负相关(r=-0.383,P=0.016),与NT-proBNP水平呈正相关(r=0.296,P=0.037)；血清TNF-α水平与LVEF均呈负相关(r=-0.425,P=0.008),与NYHA心功能分级(r=0.305,P=0.030)及血清NT-proBNP水平(r=0.377,P=0.017)均呈正相关；血清NF-κB水平与LVEF(r=-0.317,P=0.028)呈负相关,与NYHA心功能分级(r=0.304, P=0.031)及血清NT-proBNP水平(r=0.246,P=0.043)均呈正相关。CHF患者TNF-α水平与6MWT呈负相关(r=-0.369,P=0.018),与血清IL-22(r=0.413,P=0.010)及NF-κB(r=0.356,P=0.021)水平均呈正相关。ROC曲线分析发现,6MWT、血清TNF-α及NF-κB水平联合预测CHF患者不良预后的ROC曲线下面积为0.991(95%CI 0.939~1.000),灵敏度为0.972,特异度为0.977,优于单一指标检测。Cox风险比例回归分析显示,6MWT及血清TNF-α水平是影响CHF患者出院后1年发生不良终点事件的独立危险因素。结论 6MWT、TNF-α、IL-22及NF-κB联合应用对CHF患者预后有良好的预测价值。 |
| 英文摘要: |
| Objective To explore the value of 6-minute walk test (6MWT) combined with serum cytokines in evaluating the prognosis of chronic heart failure (CHF). Methods A total of 82 CHF patients admitted to our hospital from January 2020 to January 2021 were selected as the study subjects. Their clinical data and cardiac function indicators such as left ventricular ejection fraction (LVEF), New York Heart Association (NYHA) class, and serum N-terminal pro-brain natriuretic peptide(NT-proBNP) levels were collected. 6MWT test was conducted on all of them after admission. The serum levels of cytokines, including interleukin-22 (IL-22), tumor necrosis factor-α (TNF-α) and nuclear factor-kappa B (NF-κB) were detected and recorded. SPSS statistics 19.0 was used for data processing. Pearson or Spearman correlation analyses were employed to analyze the correlation of 6MWT results and serum cytokine levels with cardiac function indicators. Receiver operating characteristic (ROC) curve was plotted to assess the predictive values of various indicators for the prognosis of CHF patients. Cox risk proportional regression model was applied to analyze independent risk factors affecting the prognosis. Results During 1-year follow-up, 2 patients were lost. The other patients were divided into event group (n=36) and non-event group (n=44) according to the occurrence of adverse end points. The patients in the event group had significantly shorter 6MWT distance [(301.25±36.78) vs (413.51±42.36) m], and obviously higher serum levels of IL-22 [(643.51±53.69) vs (511.07±60.11) pg/ml], TNF-α [(412.15±56.69) vs (284.55±35.79) ng/L] and NF-κB [(96.67±13.69) vs (70.05±12.57) pg/ml] when compared with those in the non-event group (all P<0.05). Opposite results [6MWT distance:(390.52±45.87) vs (346.47±43.15) m; IL-22:(540.09±60.33) vs (589.01±58.77) pg/ml; TNF-α:(325.21±53.69) vs (352.02±54.77) ng/L; NF-κB:(78.07±10.85) vs (84.04±11.33) pg/ml] were observed in the patients of NYHA class Ⅱ than those of NYHA class Ⅲ (all P<0.05). Correlation analysis showed that 6MWT result was positively correlated with LVEF in the CHF patients (r=0.511, P<0.001), and negatively with NYHA class (r=-0.405, P=0.012) and serum NT-proBNP level (r=-0.456, P<0.001); serum IL-22 level was negatively correlated with LVEF (r=-0.383, P=0.016) and positively with NT-proBNP level (r=0.296, P=0.037); serum TNF-α level was negatively correlated with LVEF (r=-0.425, P=0.008), and positively with NYHA class (r=0.305, P=0.030) and serum NT-proBNP level (r=0.377, P=0.017); Serum NF-κB level was negatively correlated with LVEF (r=-0.317, P=0.028), and positively with NYHA class (r=0.304, P=0.031) and serum NT-proBNP level (r=0.246, P=0.043). The TNF-α level was negatively correlated with 6MWT result (r=-0.369, P=0.018), and positively with serum IL-22 (r=0.413, P=0.010) and NF-κB levels (r=0.356, P=0.021). ROC curve analysis found that the area under the curve of combined 6MWT result and serum TNF-α and NF-κB for predicting poor prognosis in CHF patients was 0.991 (95%CI 0.939-1.000), with a sensitivity of 0.972, and a specificity of 0.977, and all these values were superior to those of a single indicator. Cox risk proportional regression analysis indicated that 6MWT result and serum TNF-α level were independent risk factor for adverse end points in CHF patients within 1 year after discharge. Conclusion 6MWT result combined with TNF-α, IL-22 and NF-κB levels shows good predictive value for the prognosis of CHF patients. |
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